Traveller’s diarrhoea (TD) can be very unpleasant and ruin a holiday or business trip. It is estimated that as many as 60% of all travellers will experience a bout of TD when they travel overseas. Many illnesses such as Hepatitis A, Typhoid and Cholera are spread through eating and drinking contaminated food and water. Thankfully, there are vaccinations that can offer some protection against these illnesses. However, many other bacterial infections such as E.Coli and parasites such as Giardia cannot be vaccinated against. It is extremely important to follow strict food and water hygiene to avoid infection.

Advice for Travellers

• Drink bottled water. Beware of fake bottled water- in many countries seals have been tampered with and the bottle actually contains unsafe tap water.
• Avoid ice in your drinks, unless you are sure it has come from a safe supply of water.
• Don’t clean your teeth with tap water- use bottled or boiled water.
• Boiled water is safe to drink- bringing water to the boil and boiling for 1 minute is enough to purify it.
• Use chlorine tablets or a water filter if you haven’t got access to clean drinking water.
• Avoid salads that may have been washed in unsafe water.
• Avoid raw fruit and vegetables- these are ok if you can peel them.
• Avoid buffet food that may have been left out for a number of hours or been exposed to flies.
• Avoid unpasteurised dairy products such as milk, yogurt and cheese.
• Always wash your hands well before you eat and if you don’t have access to washing facilities carry an alcohol hand gel.
• Avoid street food, unless it is cooked freshly in front of you.
• Don’t assume food served in a 5* hotel will be safe- staff may not have practiced strict food. Water and personal hygiene.

Prevention

Bimuno is a pre- biotic powder or pastille that can keep your tummy healthy on a trip abroad. Clinical studies have shown it to be effective in reducing your risk of TD. It works by sustaining a healthy level of good bacteria in the gut, helping to prevent bad bacteria from becoming established.

Ask your nurse about water purification products – Bimuno, Chlorine Tablets and Water Filters or purchase online in our shop.

Mosquitoes are the vector of malaria which is spread at night. They also spread other diseases such as; Dengue fever, Yellow fever, Japanese B encephalitis, St Louis encephalitis and Bancrofti and Filariasis. Some of these diseases are spread by daytime biting mosquitos. The best advice is to avoid mosquito bites.

Insect Bite Avoidance

•  To avoid bites wear clothing that covers as much of the body as possible.
•  Wear long-sleeved clothing and long trousers when going out at night.
•  Protect feet with appropriate footwear.
•  Use insect repellents on exposed skin.
•  Insect repellents are available in various forms and concentrations.
•  Many skin preparations are available, mostly containing di- ethyltoluamide  (DEET)
• For those allergic to DEET, alternatives include Lifesystems Natural repellent.
• Use a mosquito net when sleeping in unscreened accommodation. Mosquito nets should be impregnated with a long lasting insecticide. It can be helpful to practice erecting nets before departure.
• Use air conditioning in your hotel room, if available.
• If possible, avoid going out between dusk and dawn when mosquitoes spreading malaria commonly bite.
• Use anti-mosquito insecticide dispensers (mains or battery operated that contain tablets impregnated with pyrethroids or burn pyrethroid mosquito coils in bedrooms at night) Electronic buzzer’s do not work.

MALARIA – REMEMBER MALARIA CAN BE A FATAL ILLNESS

It is essential to complete your course of malaria tablets to get full protection. Keep taking them when you get home as prescribed.

Initial symptoms of malaria can often be mild, difficult to recognise and can be confused with flu. If you develop flu-like symptoms once you return home, seek medical advice immediately and tell them you have recently returned from a malaria- risk zone. This will enable a speedy diagnosis and could potentially save your life.

We stock a full range of mosquito nets, insect repellents and other travel related equipment – ask your nurse for more details.

We have been informed by the manufacturers of the following vaccines that there will be a supply problem for the foreseeable future.

GlaxoSmithKline (GSK) has announced that supplies of Typhoid Vaccine and Combined Hepatitis A/ Typhoid vaccine will not be available until the second quarter of 2014. The delay in supply has been constrained due to a delay in a new manufacturing facility.GSK has had to concentrate production on critical childhood vaccines as prioritised by the World Health Organization.

Sanofi Pasteur MSD has reported a temporary interruption to supplies of Typhim Vi, Typhoid Vaccine. Supplies will become available from the end of February 2012.

How will this affect me?

Sussex Travel Clinic has adequate supplies of Oral Typhoid vaccine available and plenty of Hepatitis A vaccine in stock.

Hepatitis A and Typhoid are caught through consuming contaminated food and water. If you are travelling to a country where these diseases are common it is important you get vaccinated before you travel.

Please call 01273 749100 to book an appointment.

I was very saddened to hear of the awful tragedy over the weekend of Costa Concordia cruise ship that hit a reef and ran aground off the coast of Tuscany, Italy. The awful tragedy saw 6 people lose their lives with another 15 passengers and crew still unaccounted for .It was even more poignant for me as two months to the day my husband and I had been on that very ship taking a seven night cruise around the Mediterranean.

I can only imagine how frightening the whole episode must have been for those involved. I expect the mood would have upbeat on the ship on Friday evening before the tragedy. The ship would have departed earlier from the port of Civitavecchiaand been on its way to Savona. The passengers would have been enjoying a seven course Gala dinner by candlelight when the ship hit the reef. Luckily, most people where able to get off the stricken ship, however reports in the media are that the evacuation was chaotic with many passengers not having attended a muster safety drill. When we were on the ship our muster drill was on the day we arrived, however with so many nationalities on the ship, the drill was presented in several different languages and it was quite hard to hear what was being announced. The Costa Concordia is a very large cruise ship that carries up to 4000 passengers so I would imagine evacuation on a ship that size would always be difficult.

This tragedy highlights the importance of safety drills on both ships and planes. On cruise ships all passengers must attend a muster safety drill within 24 hours of departure. The purpose of a muster drill is to prepare passengers for safe evacuation in the event of an emergency while on board the ship and to familiarize passengers and crew with escape routes. In the case of the Costa Concordia many passengers are saying that they had not attended a safety drill when the ship got into trouble. Maybe lessons will be learnt from this and it will become law that safety drills are carried out before departure.

Our thoughts are with all of those involved and the families of those that died and are still missing.

Have you ever been evacuated from a ship or plane? Share your stories with us.

According to a recent report on Promed, the Department of Health in Australia is warning Western Australians against having tattoo’s abroad. This is in response to a confirmed case of HIV in an Australian where evidence of infection points to a recent tattoo received in Bali, Indonesia.

Having tattoo’s, body piercing and acupuncture abroad is not advised. While tattooists in the UK and Australia must comply with a code of practice and strict regulations, this is not always so in tattoo parlours overseas. Equipment used can be contaminated with blood and can pose a risk of contracting blood- borne infections such as HIV, Hepatitis B and Hepatitis C. These blood – borne infections are transmitted through blood to blood contact or sexual activity. Hepatitis B can be prevented by having a course of vaccinations; however HIV and Hepatitis C are not vaccine preventable.

Advice for Travellers

• Do not have body piercings, tattoo’s or acupuncture abroad.
• If possible avoid having medical or dental treatment abroad,
• Never have unprotected sex, Always practice safe sex. Make sure you take an adequate supply of condoms for your trip.
• If you have to buy condoms abroad, make sure they are in date and carry a recognised quality mark.
• Consider taking a Sterile Medical Kit with you if you are travelling to areas where medical facilities may be poor.
• Do not take drugs. Never share drug equipment.
• Do not share razors, toothbrushes or nail scissors.
• Consider having a course of Hepatitis B vaccine before you travel, especially if you are planning a long stay trip or are going to remote locations.
• Consider joining the Blood Care Foundation. The Blood Care Foundation is a charitable, not for profit organisation, The Foundation operates a Blood Care Programme, which is designed to provide screened blood, in an emergency, to its members in any part of the world.

In our third question and answer post we look at a common question we get asked when travelling to the Gambia.

Q: Do I need to take malaria tablets for a holiday to The Gambia?                             

 A. Yes malaria tablets would be recommended for a trip to The Gambia. Between October and December 2011 18 cases of malaria were imported into the UK and found to be associated with travel to The Gambia. 7 of these cases were in holidaymakers. Malaria is spread through the bite of an infected mosquito and can be fatal. The preventative steps to be taken to avoid mosquito bites include using a Deet based insect repellent, sleeping under a mosquito net and covering up as much skin as possible with loose clothing.  Appropriate anti -malarial medicines can be obtained by consulting with your travel health nurse . You need to take these before, during and after travel. Your nurse will advise which tablets will be most suitable and explain any potential side effects. It is important to know that malaria is not entirely preventable so all travellers should seek immediate health advice if they become unwell following a holiday to a malaria risk area. Symptoms of malaria can be any of the following; diarrhoea, flu like symptoms headache and fever.

You should also ensure you have had all of the recommended vaccinations for travel to The Gambia.

To book an appointment at Sussex Travel Clinic call 01273 749100 or book ONLINE

In the second part of our question and answer posts we look at Rabies vaccination.

Q: I am planning to back pack around South East Asia for 2 months should I have the rabies vaccine?

A: Yes we would definitely recommend a course of rabies vaccine. Rabies is spread through a bite, scratch or a lick on broken skin from an infected animal. It is estimated that there are between 50000 and 60000 deaths from rabies worldwide each year. Over half these deaths occur in South East Asia and rabies is almost always fatal.

If you do not have pre-exposure rabies vaccine before you travel you would require a treatment called rabies immune globulin (RIG). This must be administered within 24hrs following a bite/lick/scratch from a potentially infected animal. Human RIG is manufactured from the blood of immunized volunteers. Receiving any blood product abroad is never recommended unless you can be certain it has been screened for blood borne diseases such as H.I.V.  RIG is not always available in many developing countries.

Having three doses of rabies vaccine pre-travel eliminates the need for R.I.G and primes your immune system so that treatment after exposure would be successful.

If you are travelling to a rabies endemic country for 4 weeks or more, or likely to be more than 24 hours away from good medical facilities and a reliable source of RIG, you should consider getting a course of rabies before you travel. The vaccine is given on days 0, 7 and 21 or 28.

To book an appointment at Sussex Travel Clinic call 01273 749100 or book ONLINE

Over the coming weeks I will be posting some common questions that we get asked at the Travel Clinic. This week’s post looks at vaccinations required for travel to Egypt.

Q: I am travelling to Egypt for a 2 week holiday, do I need any vaccinations or malaria tablets?

A: Egypt is becoming an increasingly popular destination for UK travellers. The year round climate makes it the perfect choice for those wanting to escape the UK weather for some guaranteed sunshine all year round. Many people who book a holiday to Egypt do not realise that any vaccinations are required.

The recommended vaccinations for travel to Egypt are Diphtheria, Tetanus and Polio, Hepatitis A and Typhoid. Protection against food and water-borne diseases such as Polio, Hepatitis A and Typhoid are very important as you could become infected through eating or drinking contaminated food or water. Staying in a 5* hotel does not reduce your risk, as the people preparing your food may live in areas where sanitation is poor and could pass on these diseases whilst preparing your food.  

Malaria tablets are generally not required for Egypt, as malaria is not present in the popular tourist destinations. However, there will still be lots of mosquitoes around, so you should take a good DEET based insect repellent to apply on your skin and help you avoid bites. Book an appointment with your travel clinic, ideally at least 2 weeks before departure, to get your vaccinations and to get further travel health advice on food and water hygiene and mosquito bite avoidance.

Egypt is a high risk destination for traveller’s diarrhoea. Bimuno has been shown to reduce your risk of getting diarrhoea- Available to purchase in clinic.

To book an appointment at Sussex Travel Clinic call 01273 749100 or book ONLINE

The rabies virus is spread through the bite or scratch of an infected warm –blooded animal, most commonly dogs, and is nearly always fatal.  The virus attacks the central nervous system, causing paralysis, encephalitis and coma.

The World Health Organisation estimate that, more than 3 billion people are at risk of contracting rabies in at least 85 countries worldwide, with the annual number of deaths worldwide caused by rabies is estimated to be between 50,000 and 60,000. [1].

In this weeks post we look at countries reporting rabies in 2011.

 Countries Reporting Rabies cases in 2011 (June – December)

Angola

Angola is reporting an increase in rabies in animals during 2011. 405 people have been bitten by potentially rabid animals with 12 deaths since the beginning of the year.

Australia

A women from Brisbane in Queensland, Australia received rabies post-exposure prophylaxis following an attack by three foxes or fruit bats while she was on her balcony.

Bhutan

In 2011 it has been reported that five people have died from rabies in Bhutan. Dogs accounted for 39% of the cases, while the main transmitters of rabies in Bhutan are cattle 55%

Bolivia

Bolivia had reported at 60% increase in cases of canine rabies in 2011. There have been 208 confirmed cases of canine rabies with three human deaths reported in 2011.

China

In Shanghai  it has  been reported I that during 2011 there has been an increase of dog attacks on residents.40,000 people have been bitten by a pet, a 40% increase from 2010. In 2010 there was 1 case of rabies, this year 6 cases have been reported. Beijing reported six human deaths from rabies in the first six months of the year and in Chongqing in Southern China there were a total of 38 deaths from rabies in the first half of the year.

Ecuador

A total of nine human deaths from rabies were reported by the ministry of Health of Ecuador on 28 Nov 2011. An on-going mass vaccination programme is being conducted in the affected communities in canton Taisha, Morona-Santiago.

India

In Chennai at least 20 people have died of rabies in the first half of 2011. General hospitals in Tamil Nadu reported 12 deaths due to rabies in 2010. In Visakhapatnam, sea port on the south east coast of India a rabies death was reported in July 2011 and a boy died in the Khammam district. also in July 2011.

Indonesia

The rabies epidemic continues in Bali, as of June 2011, over 100 deaths caused by rabies have been reported. In Borneo at least 858 rabies cases have been reported, including one death. In east Nusa Tenggara a total of 800 dog bites have been reported this year.  An on-going shortage of rabies vaccine has been reported in Kab Sikka regency and in other areas of the province.

Kazakhstan

In July 2011 a 10-year-old boy was hospitalized in the KyzylordaOblast with suspected rabies.

Pakistan

Rawalpindi city has reported an increase of dog attacks on residents.  Every month more than 100 dog-bite cases are being with the number continuously on the rise.

Peru

In 2011 a total of 20 human rabies cases have been reported so far. Of the 20 deaths 19 were in natives of the Amazonas region who were bitten by bats. In a remote village in the Atalaya province a rabid cattle had to be slaughtered and a total of 87 people consumed the infected meat in November 2011. All persons involved received rabies post-exposure prophylaxis.

Russia

In the first nine months of 2011 in Russia ten people contracted rabies, of which three cases were reported in the Tverskaya province. In 2010 there were 17 cases of human rabies in the Russian Federation.

Svalbard and Jan Mayen (Norway)

Three reindeer were reported to have tested positive for rabies on 27 Sept 2011.

Ukraine

Ukraine has reported 5 cases of human rabies in 2011. 100,000 – 120,000 people seek medical treatment for animal bites every year in the Ukraine.

USA

There have been reports of rabies cases in racoons in Florida in 2011 and in Texas they are reporting a rise in the cases of animal rabies with 591 reported in the first six months of the year. In Jul 2011, a 73-year-old woman tested positive for rabies. She was bitten by a dog in her native Haiti in Apr 2011. Animal rabies was also reported in Illinois and New York.

Vietnam

In June 2011 an outbreak of rabies amongst domestic dogs in the Si Ma Cai District of northern Lao Cai Province was reported.

 Zambia

In October 2011 an outbreak of rabies was reported in Mansa district with 14 cases. One human death was reported in Mwang’uni , the person had become infected after being bitten by a dog.

Advice for Traveller’s

If you are travelling to country where rabies is present for 4 weeks or more, or if you are likely to be more than 24 hours away from a reliable source of vaccine and treatment, then you should consider having a course of rabies vaccines pre travel. Many countries do not have a supply of rabies immunoglobulin, the treatment you need if you have not had any rabies vaccines, so you should consider having the vaccine before you go.

To book a rabies vaccine please call 01273 749100 or book ONLINE

References

1. www.nathnag.org